MHA Today | December 2, 2016

December 2, 2016

MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.

Insights

Several weeks ago, MHA released research on the influence of adverse childhood experiences on health. The research was released in coordination with the Kansas Hospital Association. KHA President and CEO, Tom Bell, and I co-authored a commentary on the problems of ACEs that was published in The Kansas City Star and AHA News.

Many of the problems that manifest on the front lines of care begin far upstream of our emergency departments, inpatient beds and outpatient exam rooms. The research was designed to help hospitals and other stakeholders begin to understand and effectively invest in programs that mitigate the long-term effects of ACEs. The column follows.

Long-term and often invisible damage can be caused by childhood abuse and neglect, a troubled home or toxic stress. These factors can influence an individual’s physical and behavioral health throughout life — and even result in early death. Research suggests that this damage is compounded by multiple adverse childhood experiences.

No Missouri or Kansas community is immune from these factors. Sadly, some are at high risk for all.

Resilient KC’s website allows members of the community to develop a personal ACE score. Unfortunately, a personal ACE score is a “downstream” score. The Kansas Hospital Association and Missouri Hospital Association wondered whether a community-level score could be developed to help stakeholders identify the home- and community-based risks for ACEs to help steer assets toward these high-risk targets. This would focus resources more effectively on ACE prevention.

In first of its kind research, the Kansas Hospital Association and Missouri Hospital Association were able to deliver a community ACE score at the ZIP-code level for communities in both states. The risk analysis, developed by the Hospital Industry Data Institute, aggregated three years of hospital inpatient, outpatient and emergency department data at the ZIP-code level for Kansas and Missouri. The review included hospital codes for 25 measures attributed to abuse, neglect, household challenges and toxic stress factors.

The data are alarming. High-risk ZIP codes can be found throughout each state, including rural and urban communities.

In the Kansas City metro area, high-risk areas were apparent in Kansas City’s core ZIP codes and stretched across Jackson County and into much of Wyandotte County. The majority of ZIP codes in northern and western Jackson County also were identified as high risk.

There’s more. Communities with high gun violence were found to be highly correlated with negative childhood experiences. Between 2006 and 2015, Kansas and Missouri rates of gun-related hospitalization and pediatric stress diagnosis in the top 20 ZIP codes were significantly higher than statewide rates. In Kansas, the top 20 ZIP codes for gun violence had a 233 percent higher rate than statewide. In Missouri, the top 20 had a 845 percent difference. The rate of childhood stress diagnoses in the top 20 ZIP codes for gun violence in Kansas and Missouri was 55 percent and 75 percent higher, respectively.

Treating the cumulative effects of ACEs long after the fact is costly to the health care system and the individual. And evidence suggests the downstream costs of Kansas City-area childhood trauma are high.

A profile of work being done at Truman Medical Center-Behavioral Health in Kansas City found that many of the center’s clients suffer from significant physical and behavioral health problems resulting from traumatic childhood events. Many of these clients come from the ZIP codes with the highest ACE scores in the greater Kansas City area.

Although the risk-based modeling in the research is preliminary, a ZIP-code-level tool holds promise for hospitals and their partners’ collaborative population health improvement efforts. Nonetheless, better identification of communities with high risk for ACE can improve stakeholders’ targeting of limited resources.
Situated at the confluence of the Kansas and Missouri rivers, Kansas Citians know that what happens upstream matters.

Other partnerships, in Kansas City and throughout the state, are forming to address ACEs and other upstream influences on health. In the future, this type of research can help inform our community investments so that every hospital and stakeholder dollar counts.

CMS Selects Random Sample Of Hospitals For Validation

The Centers for Medicare & Medicaid Services Hospital Inpatient Quality Reporting Program has selected the random sample of hospitals for validation of chart-abstracted and health care-associated infection measures for the fiscal year 2019 annual payment update determination. The time period included in FY 2019 inpatient validation are third quarter 2016, fourth quarter 2016, first quarter 2017 and second quarter 2017. The list of hospitals is available on QualityNet. Hospitals selected for validation will be notified by CMS of associated validation requirements and deadlines.

An additional sample of up to 200 targeted hospitals will be selected in April/May of 2017. CMS will include all hospitals that failed validation for the FY 2018 payment determination and a sample of hospitals meeting other targeting criteria as outlined in the FY 2014 inpatient PPS/long-term care hospital PPS final rule.

Consider This ...

The Centers for Disease Control and Prevention offers a sobering perspective. While about 78 Americans will die today after an overdose, another 580 will try heroin — or what they think is heroin — for the first time.